Essential Oils, Anemia, Teething Pain – PediaCast 298

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Join Dr Mike in the PediaCast Studio for more answers to listener questions! This week’s topics: essential oils, abnormal blood work, anemia, influenza & flu vaccine, and teething pain.

Topics

• Essential Oils
• Abnormal Blood Work
• Anemia
• Influenza & Flu Vaccine
• Teething Pain

Links

• CONTACT DR MIKE – Ask Questions, Suggest Show Topics
• CONNECT NOW with a pediatric specialist from Nationwide Children’s – Referrals and Appointments

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children’s, here is your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone, and welcome once again to PediaCast. It’s a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children’s Hospital on Columbus, Ohio. It is Episode 298 for October 15th, 2014. We’re calling this one “Essential Oils, Anemia, and Teething Pain.”

I want to welcome everyone to the program. We have a listener episode of the show lined up for you this week, so answers to your questions. I mentioned three of the topics in the show’s title. I’ll get to the complete rundown here in a moment.

0:01:06

But first, I want to remind you about our 700 Children’s Blog. It’s available at 700childrens.org – lots of great topics and trusted authors from the experts at Nationwide Children’s Hospital. And you’ll notice, it’s not just one author. We tapped into the vast resources of our entire campus of physicians, hundreds of them.

Just some recent topics that you’ll find there on the blog: the dangers of second-hand cigarette smoke, and what to expect from ear tubes surgery. So you want to check those out. And then, there’s also one that I recently wrote, called The ABCs of Homemade Baby Food or The Pros and Cons of Homemade Baby Food; seen both of those titles for it. That wraps up a trilogy of blog posts that I did on homemade baby food. We talked about nitrates being a problem, and we also talked about botulism being a problem.

So with this one, we’re going to go more the positive route and look at some of the benefits of homemade baby food. We’ll give you some safety tips on how to do at home successfully. So you’ll find that. I’m one of the authors and we have many, many more here at Nationwide Children’s. So be sure to check it out, 700childrens.org, our 700 Children’s Blog.

0:02:24

All right, so what are we talking about this week on our Listener Show? I mentioned essential oils. So they’re all the rage these days and the latest darling of the homeopathic crowd. But are they safe? Do they performed as advertised? Are they worth the money? We’ll take a candid look at those.

Also, abnormal blood work — your child gets some screening blood work and some of the values are a little off. Not a way off, just a little off. Listener recently had this experience. When should she worry? When should more be done? When do you take your child to a specialist? So we’ll take a closer look at abnormal blood work and what that means.

And then anemia – we’re going to look at a specific abnormal blood value. What is the definition of anemia? How is it diagnosed? What symptoms result? What causes anemia and how do you treat it? Let’s see, I’ve been doing these shows since 2006. We have nearly 300 episodes under our belt and we haven’t talked about anemia much at all. So today, we’re going to change that.

0:03:27

And then, influenza and flu vaccine, it is that time of year. Time to get your flu vaccine, you and your children. It’s important and highlight why it’s important. I tried to get a flu refresher in each fall. We’ll cover the nuts and bolts of the disease, including the cause, the number of people affected, how the virus causes the symptoms, what symptoms result, how it’s diagnosed and treated and prevented including information on the flu vaccine, and why you need a new one each and every year. So that’s coming your way.

And then, finally, teething pain — does teething hurt? Does it cause a fever? And what are some safe strategies for dealing with it? What are homeopathic options? We’ll sort through that topic as well. By the way, all of our topics today come from you, the listener. Those who wrote in and have written in the past, thanks for doing so. We try to answer as many listener questions as we can on PediaCast. And if you have one, it’s really easy to get in touch. Just head over to pediacast.org. Click on the Contact link and just let me know what your question is, and we’ll try to get it answered on the program for you.

0:04:31

Also want to remind you, the information presented in PediaCast — every episode, including this one — is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child’s health, be sure to call your doctor and arrange a face-to-face interview and hands-on physical examination, Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at pedicast.org.

0:05:00

So let’s take a quick break. I’ll grab a sip of water and we’ll get back, and I’ll answer your questions right after this.

[Music]

All right, we are back. I’ve gotten a couple of questions about essential oils and so I figured it was time to include that topic in the program. I feel a blog post coming on about essential oils as well. So I better get started on that. So, what are the questions. Well, first off, it’s Stephanie in Indiana. Stephanie says, “I’ve been hearing a lot about essential oils, especially within my mommy groups. Those who use essential oils state they have amazing results. The oils cure warts, help their kids sleep, and basically can be used in some way for almost every ailment.”

0:06:08

Sounds too good to be true, doesn’t it?

“I’m all for using more natural methods as in medications for managing conditions, but no one seems to know if there is any evidence-based information regarding essential oils. They also never mentioned any concerned for possible side effects. There is a significant cost to using the essential oils regularly, so I’d rather not use them unless I feel like they will be effective and aren’t just a fad. What are your thoughts on using essential oils, with a doctor’s approval, of course. Thank you.”

Along the same lines, Lori, in Salem, Oregon, says, “Dr. Mike, I’ve lived in Oregon for four years now, and I have found that many of my friends are very active users of essential oils. They give their children essential oils to heal ailments ranging from ear infections and fever, to upset stomachs, broken skin and ADHD. I know that many of today’s modern medicines are plant derived, but I have doubts about the efficacy of essential oil. From my perspective, my friend’s children do not seem to benefit from these treatments. The same friends often try to convince me that essential oils are the only way to go. What is your opinion on essential oils?

0:07:12

“I love your show, been listening to it since the beginning and I have shared your program with my pediatrician and friends. I look forward to hearing your response to my question. Best regards, Lori.”

Well, thanks for the questions, both Stephanie and Lori. So, essential oils, you know, I’m not really a fan, which probably doesn’t surprise you. But here’s my reasoning, like other natural remedies, essential oils are not regulated as a medication in the United States by the FDA, the Food and Drug Administration. Now, why is this? It’s because the makers of these substances are not marketing their products as medication. And while these products make general claims on their labels, they must also clearly state that the claim has not been evaluated by the FDA and that the product is not intended to diagnose, treat, cure or prevent any disease. You’ve seen that statement, right?

0:08:06

The FDA considers these items food supplements. So herbal remedies, essential oils, the FDA looks at these as food. And the passage of the Dietary Supplemental Health and Education Act back in 1994 shifted the burden of proof to the FDA in proving a particular food supplement was dangerous before it could step in and regulate it. In other words, as long as there isn’t a significant safety concern and as long as the manufacturer isn’t marketing the product as a true medication, then the FDA must leave the supplement alone. And as you can imagine, there must have been a lot of lobbying and backroom deals to bind the federal agencies hands in this fashion.

At least, that’s my perception of it. I don’t have proof on that, but it just kind of make sense to me. Now, here’s my question. Natural remedies are still chemicals. So whether a substance is picked out of the forest and they packaged it up for you or it’s made in a factory, at the base level, we’re still dealing with chemicals. And if we’re saying that natural remedies have one effect or another in the body, then we’re also saying that they are biologically active chemicals. So, if you’re going to put a biologically active chemical into your child’s body, do you want one that’s been thoroughly studied, whose effect is proven and whose side effects are generally known? Or do you want it to be the one that doesn’t really even hold itself out to do the thing you want it to do?

0:09:35

Now, sure many of these companies will show research across the table. Most of the time, the research is conducted by the people selling the remedy, which isn’t different from the big drug manufacturers, and yet there is a difference. The big drug companies have the FDA looking over their shoulder to make sure the research is valid. The supplement companies don’t have this check and balance in place. They don’t even have to conduct research. Now, they’ll put out a little study to convince you of their claim. But if their claims were truly significant, why not let the FDA approve them? Why not hold the remedy out as a trustworthy medication? After all, plenty of trustworthy FDA-approved medications come from plants.

So, what makes the supplement industry different? Well, I think it’s because their claims would not stand out to the scrutiny of a well-designed study, and because it would cause the company a lot of money to go that route, but most of all, because you’re going to buy it anyway.

0:10:30

By the way, there’s nothing new under the sun here. Today’s essential oils are yesterday’s herbal remedies. They’re grandmother’s swamp root. They’re your great-grandmother’s liver pills, and they’re your great-great-grandmother snake oil. But hey, we made it back around to oil. Unlike in those days, somebody’s getting rich selling the stuff. There will always be people who buy in to these claims. There were always be moms and dads who give these remedies to their kids, which is probably safe, but might not be. And these moms and dads will tell you their child improved. But we all know that in general, runny nose just get better, coughs go away, rashes clear up, skin heals, and behavior fluctuates, whether we treat them or not.

0:11:12

Personally, I think there are better things to spend my money on, but your mileage may differ.

All right, let’s move on to abnormal blood work. This one comes from Lauren in Cambridge, Massachusetts. “Dear Dr. Mike, thanks for a great evidence-based podcast. It’s a wonderful resource, and I appreciate all the work you do. I’ve been listening for years before I had kids, and now I have a three-and-a-half-year-old and a one-year-old.

“I’m writing with a question. My daughter, who is 14 months old, had blood work done as part of her nine-month-old well child visit back in January. Her platelet count and white blood cell count were elevated, so our pediatrician had us wait a few weeks and repeated the test. The results were similar. Our daughter has since been re-tested in March, May, and most recently, in early July. All her white blood cells are back in the normal range, her platelet count is still above average, and/or above the normal range. Some other values that were included in the past two or three sets of results, which were more detailed, are also consistently outside the typical range – slightly elevated percentage of granulocytes and slightly elevated percentage of lymphocytes.

0:12:19

“After the results in March, our pediatrician referred us to a pediatric hematologist who looked at the results we had at that point, reran his own test and concluded we probably had nothing to worry about. Our daughter seems healthy, is developing typically. None of her values are astronomically outside of the typical ranges and nothing was trending upwards or downwards. Most important, hematologist felt confident this was not leukemia.

“However, since that hematology appointment in March, we’ve had two more sets of lab values done at our pediatrician’s suggestion, and the values are still not in the normal range. How concerned should we be? What other things besides leukemia could cause a consistently high platelet count? Could this just be part of normal variability? In other words, the normal range is plus or minus two standard deviations from the mean, and our daughter is part of the tiny percentage of kids whose normal result is outside of that range.

“Thanks for any information you can offer. Best regards, Lauren.”

0:13:16

Well, thanks for the question, Lauren. Now, I’m going preface by saying – this is always true with PediaCast – we can’t make any medical recommendations or qualifications on any particular child. We’re not practicing medicine here. But we can talk about lab results that are slightly outside of the normal range, in general. To do that, the first thing I would say is that there’s an old saying that I learned in medical school, and that is “Treat the patient, not the number.”

So there are a lot of things that can make lab values deviate from the normal range. Some of these things are disease-related; others are not. And if your child is healthy and growing well, and your regular doctor is following the labs and specialists has looked over everything and is not concerned, then it’s probably time to stop worrying about it. If your regular doctor is repeating the blood work at regular intervals, because he thinks it’s the right thing to do medically, or because the specialists advised him to keep checking, then by all means, keep checking.

0:14:17

But if your doctor keeps drawing blood and it does sound in your particular case, Lauren, if you’ve had a lot of repeat bloods draws done, if your doctor keeps doing these blood draws because you are pressuring him into checking it over and over — and that does happen — or because you can’t sleep of night knowing the value is slightly out of range, then it would sound to me like you represent a bigger problem than the slightly-out-of-range lab value.

Now, I don’t mean disrespect in saying this, because we’ve all been there at one time or another. We get anxious over something that we’re not necessarily an expert at, and we don’t feel like the expert in the field is getting it. Now, for me, this tends to be like plumbing issues, right? I’m worried that our pipe is going to go crazy in the wall and I’m going to have water everywhere. The plumber says, “Don’t worry about it. If it happens, we’ll fix it. You can repair dry wall.” Blah, blah, blah. But I still kind of… I don’t know, I just have this worry because maybe it have had happened before.

0:15:19

There’s always something that you’re not an expert in, and you just get the sense of anxiety over the fact that something could go wrong and be wrong. And when it’s your kids, who you love, then that anxiety is magnified. Then at some point, we sort of set ourselves up as knowing more than the expert.

Now, on the other hand, if your child has symptom of one sort or another, or isn’t growing as expected, or the out-of-range number is holding an important clinical significance, then that’s a different story. You really do want to figure out what’s going in. And if there’s an upward trend or a downward trend that seems to be progressing, absolutely, you want to follow up with that. But if the lab value doesn’t really concern your pediatrician and doesn’t really concern a specialist in the respective field that we’re talking about, in this case, a hematologist, then in my experience — and again, not necessarily talking about your kiddo, Lauren, but in general — if you have your regular doctor and a specialist who aren’t really concerned about a value that’s slightly out of range and staying slightly out of range, then in my experience, chasing those kinds of numbers is not very satisfying. At some point, when we keep chasing things that aren’t really a problem, we begin to do more harm than good.

0:16:38

So like I’ve said many times on this program, either trust your doctor’s advice or find a different doctor, one you do trust. But don’t under any circumstances, try to play doctor yourself. I don’t try to play plumber. Sometimes, I play electrician, but that’s a different story. So, there are things that people are experts in the field for a reason and you got to trust them. There’s a reason physicians train for so many years, because in addition to the science of medicine, this is also a nuance art. And part of that art is knowing to be concerned and when not to be concerned.

0:17:14

So hope that helps, Lauren. As always, thanks for your loyal listening and for writing in.

Next stop, we have Natalie in Peoria, Illinois. Natalie has a simple question, “Have you done an episode on toddler anemia?” You know what? I haven’t. No, the answer is no. The reason really is because anemia is a huge topic. I mean, we could do several one-hour shows on anemia easy. So, I’m just kind of going to go through just a real quick overview of anemia. So let’s talk about it.

Most of you know the definition of anemia. It’s a decrease in the number of red blood cells in the blood. And you recall that the job of red blood cells is to… It has a substance inside the red blood cells called hemoglobin, and hemoglobin delivers oxygen. It carries the oxygen from lungs to body tissues, and red blood cells also transport the waste product, carbon dioxide, from body tissues to the lungs. So if you don’t have enough red blood cells — in other words, you’re anemic — then carbon dioxide can build up in oxygen-starved tissue.

0:18:23

Now, when it’s really bad, that can lead to tissue death. But we usually see some other symptoms long before it gets that bad.

By the way, kind of going after that last question that we did with abnormal blood work, anemia is one of those things that if it’s a little bit low, and especially if it’s trending down, that is definitely one of the lab works needed that you would want to be concerned about because it’s clinically significant. Remember, I mentioned, if the lab work is clinically significant and a downward trend on your hemoglobin or hematocrit — which is how we measure red blood cells — that is an issue, and something that we want to follow.
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0:19:02

Now, before you get the tissue death from not delivering enough oxygen, you’re going to see other symptoms long before it gets that bad. Things like fatigue, weakness, pale skin, a faster heart rate to recycle the red blood cells that you do have more quickly. And then, as anemia gets worse, you may see shortness of breath, chest discomfort, dizziness, difficulty concentrating. But of course, early on with anemia, there may be no symptoms at all.

Now, we measure red blood cells in a number of ways. As I mentioned, hemoglobin and hematocrit, those are a part of a complete blood count and these numbers drop low when anemia is present. But there’s some other numbers that we look at, which describe the size and contents of individual red blood cells and that can help us make conclusions as to the cause of the anemia.

So let’s talk more about that, the cause. We can divide the causes of anemia into two broad categories. The first, things that destroy red blood cells that have already been made, and then things that decrease the body’s ability to make new red blood cells. Either of these conditions would result in fewer red blood cells, right?

0:20:09

So let’s look at red cells being destroyed first. What could cause this? First, it’s chronic bleeding. So a small amount of bleeding over a long period of time especially in the GI tract. It’s not really destruction of red blood cells but it’s a loss of them nonetheless. And then hemolytic anemia, this is where red blood cells actually get destroyed in the blood stream. Hemoglobin gets released, the body processes the hemoglobin and one of the byproducts of that is bilirubin, which makes you jaundice. So hemolytic anemia can result in jaundice, and elevated bilirubin levels is one of the things that makes us suspect that there could be a hemolytic anemia going on.

What causes this destruction of circulating red blood cells? It can be auto-immune. So your immune system, there are antibodies that are attacking the red blood cells. That’s one possible cause.

0:21:04

Another is a genetic abnormality in red blood cell characteristic. So, sickle cell anemia and beta thalassemia, hereditary spherocytosis — these are all examples of things that are genetic, that will result in an abnormality in red blood cells.

What about red blood cells not being made? Well, if any of the building blocks of red blood cells are missing or low, then you would have trouble making new red blood cells. And since red blood cells have a limited life span in circulation, as you lose red blood cells naturally, you got to be able to replace them. And if you’re missing building blocks, you’re not going to be able to make them. So what are some of those building blocks? Iron is very important in the production of hemoglobin. So iron deficiency anemia is probably the most cause of anemia in toddlers.

Certain vitamins, if they’re deficient can also result in anemia — things like vitamin B12 and folate.

0:22:06

Lead poisoning can lead to building block problems and the anemia. Chronic disease, especially underlying inflammatory diseases can also result in building block problems so that red blood cells don’t get made as easily. It can also be a problem in the bone marrow itself where the stem cells are, that are making red blood cells. We call this an aplastic anemia, if there’s a problem with the stem cells. Things that can cause that are cancers like leukemia, auto-immune. So again, your immune system can cause that.

Also, infections in certain drugs as an adverse reaction can cause an aplastic anemia, or problem with red blood cell production in the bone marrow.

Now, really, this is an abbreviated sampling of possible of causes of anemia., There are many, many more. And anemia is one of those situations where doctors really do get to put on their detective hat to try to figure out exactly what’s going on. If your regular doctor can’t get to the bottom of it, then they’ll likely refer you to a hematologist, and that referral would probably happen sooner rather than later if the anemia is severe or trending down.

0:23:15

Now, for toddlers, the most common cause is probably, as I mentioned, iron deficiency anemia. Lead poisoning used to be more common and still may be a concern in some communities and some families and situations. And of course, there are many other things that we talked about that can happen in toddlers, just as it can in any other age range.

So what about treatment? Well, if the anemia is severe, you might need an infusion of packed red blood cells. Fortunately, most anemia are discovered before a transfusion would be necessary. OK, so what other treatment options come into play? Well, that depends on the exact cause of the anemia. And to figure out the exact cause, as I mentioned, your doctor may have to do a bit more investigating. Once we know the cause, we have a better idea of how to treat it.

0:24:03

So iron deficiency, we would treat by supplementing iron. If you have a vitamin B12 or folate deficiency, we would supplement those vitamins. If you have lead poisoning, we want to remove the source of the lead, and some kids might even need chelation therapy to remove the lead from their body. And if it’s an immune system problem, then we may need to give medication that decreases immune system activity for a time.

So that’s anemia in a nutshell. I could easily, as I mentioned, do several long shows on the various types of anemia. But the bottom-line is this, you don’t have enough red blood cells for one reason or another. This begins the cause symptoms because you’re not getting enough oxygen to tissues and carbon dioxide is not being taken away from the tissues. This can lead to the death of tissues and to the death of the person, if it’s severe enough. After all, your cells do not oxygen. Once you discovered the number of red blood cells as too low, you have to figure out why. And once you know why, you can customize a treatment plan.

0:25:03

For toddlers, iron deficiency is at the top of the list and we treat by giving iron supplements for a few months, but we also have to consider things like lead poisoning, vitamin deficiencies, infections, auto-immune disease and inherited blood disorders, things like sickle cell anemia, thalassemia and hereditary spherocytosis.

Anemia, it’s a great big topic, which is probably why we haven’t really done it as a nuts-and-bolts show. But hopefully, we have enough points, Natalie, to satisfy your curiosity. Definitely, thanks for writing in.

Next up, we have Megan in Indiana. Megan says, “How long is a flu vaccine effective? If I understand it correctly, since the outbreak of H1N1 a few years ago, the seasonal flu vaccine has included that strain. If I receive the vaccination last year, is it still effective a year or two or ten down the road, like MMR vaccine, for instance? Or it necessary to continually be vaccinated for that same strain each year? If so, why is that? Why isn’t it effective for life instead of just for a season?”

0:26:05

It’s a great question, Megan. And I’m going to expand the answer out to include information about the flu, in general. I try to do this every year. Since flu season will soon be upon us, I think it’s a good time to talk about influenza and flu vaccines again.

So if you thought enterovirus D68 is bad, well, the flu can be much worse, and definitely causes more deaths. So, please be sure to get yourself and your children vaccinated against the flu. You do need a flu shot every year, and we’ll explain why here in a moment. But let’s run through flu basics again and then we’ll wrap things up with answers to Megan’s questions regarding flu shots.

So what is the flu? it’s a viral disease caused by the influenza virus, and the influenza virus is a respiratory virus. So it’s going to invade the lining of the nose, throat and lungs. Just think the respiratory tract, and that’s where influenza lives.

0:27:06

Now, influenza, it can be divided up into two main types based on a protein that is on the surface of the virus: influenza A and influenza B. Now, influenza A can be divided into subtypes based on a couple more surface proteins, and then those two subtypes — or the subtypes that are around — can be divided into many strains based on other proteins that are on the surface of the virus.

Influenza B is not divided into subtypes but there are many strains. Again, the different strains are just different proteins that are on the surface. Your body’s immune system is really responding to those proteins so the antibodies are against specific proteins on the outside of the virus. Now, the problem with influenza is that it is frequently mutating, so these proteins change. So you may make immunity against one strain of influenza A or influenza B, but that’s not going to protect you against another strain. And there lots of different strains and they’re constantly mutating, and we have different ones floating around communities each year.

0:28:18

And so that’s why you need a flu shot each year. Because different strains are coming, and so you need to be vaccinated against the strains that we think are going to be in your community in that given year. An epidemiologist and people who make their living deciding these things predict which influenza strains are going to be in your community in a given year, and those are the strains that are going to be in the flu shot.

Now, does that mean you have life-long protection against the strains that are in the flu shot you got, and it’s just that each year, you get a different flu shot? No. As it turns out, immunity against these protein is short-lived. And we don’t really understand exactly why that is, but there’s a lot of research going in to trying to find different proteins on the surface of the flu that are more stable ones and that will give us life-long immunity, or at least long-term immunity as opposed to one season’s worth of immunity. But as it is right now, the best that we have is getting a yearly flu shot with short-lived immunity against the different strains that they predict are going to be here.

0:29:26

So I hope that makes sense. Exactly why we have short-lived immunity against the proteins on the surface of the influenza virus, we don’t understand that. And it just is, and it does not give us long-term immunity. But there are folks working to try to figure out why and to come out with influenza vaccine that would give us longer immunity.

So how big of a problem is this? Well, influenza affects millions of people around the world each year. In the US, influenza-associated deaths between 1976 in 2007 have ranged from just over 3,000 deaths a year to one year. Almost 50,000 deaths again between 1976 and 2007. That ends up being from 1.4 to 16.7 deaths per 100,000 people. Last year, in the United States, it was just over a hundred kids that died from the flu.

0:30:20

Now, if enterovirus D68 or any other new infectious disease were to come into the United States and you heard, “Hey, this is killing a 100 kids,” you’d be worried about it. But sometimes, we just kind of roll our eyes at the flu. “Well, it’s just a flu.” But the flu killed over a hundred kids last year.

So flu shots are important. And make sure that you and your kids get your flu shots this year. Those who are most at risk are going to be infants and young children. The highest risk for premature babies, the elderly, pregnant woman, those with weakened immune systems from things like chemotherapy, HIV, other immunodeficiencies, those with underlying respiratory illness — things like asthma, cystic fibrosis, bronchopulmonary dysplasia — and other underlying chronic diseases, things like diabetes and heart disease. So those are the folks who are most at risk. But healthy people can and do die from the flu as well.

0:31:20

What is it that the flu is doing? Well, the virus invades cells of the respiratory tract — so the nose, the throat and the lungs — and turns those cells into influenza virus-making factories. The cell is ultimately destroyed in the process and normal cell function is lost. The immune system has to come in and kills the virus and the body has to make new respiratory tract cells.

And what kind of symptoms do we see? Well, we see fever, because the body’s immune system is activating to kill the virus. We see arthralgia or muscle aches. And again, that’s a by-product of the immune system in action. We can see headache, nasal congestion, sore throat, cough. These are all things because we’re destroying the lining in the respiratory tract, and so that’s why we see those symptoms.

0:32:09

Now, when should you see a doctor for flu symptoms? Well, in general, if you’re concerned about your health or your child’s health, you should give your doctor a phone call. That’s why they’re there. But in general, if you have fever that’s lasting more than a couple of days, respiratory difficulties — it’s hard to breath, you’re breathing fast, or you’re wheezing — then you want to call your doctor right away and be seen. And if you’re having respiratory distress, you’re really having trouble and working to breathe, then you want to call 911 and activate the Emergency Medical System.

So it’s really common sense here. If you’re concerned, call your doctor. If you’re having difficulty breathing, call them sooner, rather than later. And if you’re really having trouble, make sure you get help right away.

Now, what other things can cause similar symptoms? What other viruses can do it? Rhinovirus which causes the common cold. Enteroviruses, coronavirus, adenovirus, respiratory syncytial virus or RSV, parainfluenza virus which typically causes the croup, these are all viruses that can cause similar symptoms. Strep throat can show up with a fever and a sore throat and sometimes a mild cough is associated with it. So strep throat is one of the things in the differential diagnosis, as well.

0:33:19

So, how do we diagnose it as the flu. Well, we do have a Rapid Flu Test available, and some of you may have had the nose swab up in your nose to do the rapid flu test. That gives you an answer right away. There’s a more sophisticated test called an Influenza PCR, or polymerase chain reaction. This identifies the viral genetics and takes longer, requires a special lab. It’s more expensive. And then, you can also do a viral culture but that kind of test takes a much longer period of time to get the results back.

Now, how accurate are these different types of flu tests? Well, the rapid flu test, if it comes positive, you have a pretty good idea that you have the flu. But there is a high false-negative rate,. So depending on the lab and the tests, up to a third of people who have the flu may test negative on a rapid flu test. So, we do see a lot of false-negative results with the flu. If it comes out positive, you’re probably on the flu. If the Rapid Test comes back negative, you could still have the flu.

0:34:22

Now, the influenza PCR — the one that’s looking for genetic material and requires a special lab and is more expensive — that has a high sensitivity and specificity. So, that’s a good test but not widely done, especially if you have mild symptoms with the flu. That test would be more likely to be done if you really need to know if it’s the flu and you’re sick enough to be in the hospital because of it.

And then, viral cultures, these also have a high sensitivity and high specificity, but they just take too long to really be useful. By the time you get the result of the viral culture back, your immune system has done its job and you’re probably all better. So really, it’s more helpful for epidemiological purposes when no other types of flu testing is available.

0:35:05

How do we treat the flu? The mainstay of treatment is going to be supportive care. We’re going to treat the symptoms. We’re going to use pain and fever reducers, rest fluids, salt water nose rinses, blowing the nose, suctioning the nose, humidifier in the room, those kind of things — just supportive care.

Now, there are anti-viral medications available. Things like Tamiflu that you’ve probably heard of, and there are others as well. They’re not quite like antibiotics in that even if you far into a bacterial infection, antibiotic is likely to work. With the anti-viral medicine, the sooner you get it started, the more likely it is that it’s going to have an effect. And they may not make you get better within a day or two, but they may shave off a couple of days from how long the illness would otherwise take. And it might help decrease complications from the disease.

So especially, in those high-risk groups, those folks, that’s definitely a good idea to do Tamiflu if you have the flu, because you’re the higher risk of having bad disease with the flu or getting complications. For healthy folks with mild flu-like symptoms, especially if you’ve already have them for a couple of days, it’s unlikely that the medicine like Tamiflu is going to help you anyway, so a lot of times we won’t use it in those folks. If your flu’s bad enough to be in the hospital, you’re probably going to get Tamiflu even if you’ve already have it for a few days. So just so sure, Tamiflu works best if you get it started right away, but if you’re really sick, we’re going to use it anyway.

0:36:33

Again, the mainstay of treatment really is supportive care.

Now, we’ll talk about complications. What complications can you get from the flu? The most common are going to be, especially in kids, is going to be ear infections and sinus infections. So, secondary bacterial infections, so your body is fighting the flu virus often. Mouth bacteria go up into the middle ear space or up into the sinuses and cause a bacterial infection. Or — and this is what we really worry about — bacteria going down into the lungs and causing pneumonia. And pneumonia, bacterial pneumonia, following the flu is the cause of most fatalities of the flu. So you get the flu and then, you get pneumonia, and that’s what kills people.

0:37:17

Although, you can get a viral pneumonia from the flu as well, but that’s usually not as deadly as a bacterial flu would be. Although it can be. And then, the other complication we worry about is acute exacerbations of reactive airway disease. So people with asthma, the flu may make them wheeze more, they may need more their medicine. They may end up in the hospital because of their wheezing and just like we see with enterovirus D68 and kids wheezing and having trouble breathing, the flu can do that, too — especially folks who have underlying asthma or other underlying respiratory diseases.

So the flu is something we want to prevent. How do we do that? Again, yearly flu vaccine starting at age six months is going to be though the way to go. Again, why yearly? Because the immunity that we make against this protein on the surface is short-lived. We don’t understand why, but we’re working on that. And different strains come each year, and so you do need different strains come each year and you do need different strains of flu vaccine.

0:38:23

It would be nice if they can find one protein that’s common to all flu viruses that would give long-lasting immunity. So you only needed one flu shot. That would be the perfect solution. And they’re working on it, but they’ve not had great success up till now.

By the way, there are two types of flu vaccine: the FluMist, which is a liquid in the nose that’s a live viral vaccine. Probably works a little bit better than the injection because your body responds more vigorously with an immune response to a live virus versus a killed virus. And you’re also introducing the virus in the way that the natural flu is introduced into your body, so the types of the antibodies that you make are a little bit better. So you probably do get better protection with the FluMist compared to the killed virus.

0:39:16

However, because it’s a live virus, it’s attenuated, but there is the chance that it could give you more symptoms, flu-like illness that is more severe than just you would get from the shot. And so, it’s not recommended for folks who have immune system problems, who have underlying respiratory disease, who are very young and premature, who are elderly. So the high-risk groups, it’s recommended that they get the injection which is the killed virus rather than the FluMist, which is up-to-nose, which is the live virus, and that’s the difference between the two.

Beyond the flu vaccine, how else can we prevent it? Well, really proper cough, sneezing and runny nose hygiene. Cover cough, wash your hands frequently, use hand sanitizers and avoid crowd steering flu season. You want to avoid being around people who have the flu and can give it to you.

0:40:11

So that helps, Megan, and thanks for giving me the opportunity to just of kind of do flu recap. I try to do that every year about this time, just to remind people that the flu can be bad, and it’s something that we do want to try to prevent.

All right, let’s move on to Katherine in Portland, Oregon. This is our last question of the day. She says, “Dear Dr. Mike, would you please rate the effectiveness of Camilia teething liquid. How safe and what are the side effects? Please also suggest other safe and effective teething pain relief for an 18-month-old. Thanks so much. Really appreciate your podcast. Sincerely, Katherine.”

So thanks for writing in, Katherine., I’m not really in the opinion that teething causes significant pain or fever. So if your baby has a fever or is really pretty fussy, have your doctor take a peek. Don’t assume that the problem is teething, because your child maybe experiencing symptoms of a different problem and maybe he or she just happens to be getting new teeth at the same time that this other problem is causing fussiness and fever.

0:41:14

With that said, let’s say that your child does have discomfort, mild discomfort of the gums from teething. What do you do about it? Well, my favorite thing — and what I did when they were little and they had teething discomfort — would be to use cold. So just to numb the gums with some cold things like ice, popsicles. You can take a wash rag and get it wet, put it in the freezer and you get the little ice chips that they can suck on. But whatever you have something that’s going in the mouth, supervision is key. You don’t want him to choke on something. And so, if you’re going to give him ice and popsicle or frozen wash rag, make sure you’re with them so that if they would have choking or an airway issue, you can do something about it.

But I find that cold numbing tends to really help them get through any discomfort that they have with teething. And then, as with discomfort anywhere, ibuprofen and/or Tylenol are going to be great for helping with teething discomfort. Ibuprofen is the main ingredient in products like Advil and Motrin. Acetaminophen is the active ingredient in Tylenol and there are other forms of that that are available around the world. Here in the United States, Tylenol is the main one, or a generic acetaminophen.

0:42:25

You do want to make sure that you’re using the right doses of those. But boy, they really do help if your child’s having discomfort.

What about the gum gels? Things like Orajel or Anbesol? Those should be avoided or at least used very sparingly. Personally, I’d just avoid using them altogether. Overdose is possible, and the active ingredient in those gels may cause a condition, a blood condition, called methemoglobin anemia. It’s one that was actually talked about when I talked about homemade baby food and the risk of nitrates. In that talk, we talked about methemoglobin anemia and the active ingredient in the gum gels can cause that to happen.

So, it’s probably not worth the risk of using those. Ibuprofen and acetaminophen would be preferred, and the cold even preferred over that.

0:43:18

So what about herbal or homeopathic remedies, things like Camilia? As I mentioned before, with regard to natural remedies, the packaging will say natural teething relief. But then, they’ll go on to say that this use has not been evaluated by the FDA. So the makers is not really holding itself out to do what it’s claiming that they can do. They’re not saying that yes, this will help. They’re just saying, “Hey, try this.” But your mileage may vary and we can’t guarantee what we’re saying is true.

Now, the makers of Hyland’s teething tablet, they actually include belladonna in their product. Now, sure belladonna is natural, comes from a plant. It’s also a poison and it can cause agitation, breathing difficulties, constipation, flushing of the skin, lethargy, sleeping too much, muscle weakness, problem urinating and seizures; and that’s a natural product. Now, they put a tiny amount of belladonna in the tablets. But back in 2011, the FDA charged the company with including inconsistent quantities of belladonna in their teething tablets, and that resulted in the recall of the product.

0:44:31

Now, the FDA has not charged the Hyland’s teething tablet as being unsafe. They’ve not stepped in and said, “You cannot sell this.” But there had been some issues, and you know, when you have a product that can cause the kind of side effects that I talked about, and it’s natural — again, as we mentioned earlier in the program when we were talking about essential oils — these are bioactive chemicals. They’re chemicals that are acting upon a biological system and so, there’s really not a lot of difference. At their base level, it is a chemical. The difference is what’s regulated and what’s not, what’s calling itself a food and what’s calling itself a medication.

0:45:16

Now, with regard to Camilia, really going back to Katherine’s question, the FDA has not charged that particular teething liquid. And again, this is going to be an herbal type remedy. The FDA has not charged Camilia as being unsafe, then it probably is fine to use. But will it really help your child’s discomfort? Maybe, maybe not.

For me, I’d advise lots of parents to use ibuprofen, acetaminophen and cold for teething discomfort. With regard to ibuprofen and acetaminophen, these medications are regulated by the FDA. Yeah, they’re biologically active chemicals, just like what the folks who make Camilia are saying their products will do, but these are biologically active chemicals we know a lot more about. They’ve been shown to do what the manufacturer says that their product will do. Side effects are few and toxicity is predictable.

0:46:17

So that’s where I’d spend my money, on something that you know that works and has a good safety profile. And, of course, don’t forget supervised cold because I think that helps, too. And that other than the choking hazard, that’s the safest of all.

Now, if you’re worried about giving too many doses of ibuprofen or too many doses of acetaminophen or Tylenol for teething pain, then I’d second-guess if teething is really the problem. Because as I’ve said before, I’m not really of the opinion that teething in and of itself represents a significant discomfort.

Yeah, there are a couple of safety issues with ibuprofen and Tylenol. With Tylenol or acetaminophen, a large dose of that can actually cause liver problems. Acetaminophen can be very dangerous in a large overdose situations, so you want to make sure you’re using the right amount and that you’re using the right time period between doses and that you’re not using it too long. So this really ought to be used in conjunction with your doctor. Let your doctor know, “Hey, my baby’s teething and really fuzzy, what’s the right dose of Tylenol, and how long can I use it? How many hours between doses?” and all that. And as long as you’re doing what your doctor’s advising, then you can rest that it’s safe, because we know a lot about it.

0:47:38

And the same things true with ibuprofen as well, that went not so much an issue with the liver, with overdoses, but it can cause some kidney issues and we don’t want to use ibuprofen in children less than six months of age. Too much of it can also be a problem. But remember, we’re talking about large amounts of too much. So, with the recommended doses, it’s very safe to use these medications, and has been well-studied by the FDA, with many, many miles of actual use on the road. You know what I’m saying? Whereas other things, the homeopathic things that are out there, we know much less about.

0:48:17

So I hope that helps Katherine. Teething discomfort, go with cold first. Ibuprofen, Tylenol, those are the mainstays. But if your child is really in a lot of discomfort or having a fever, make sure you call your doctor and find out exactly what’s going on there.

All right, that does wrap up our listener questions for this week. Don’t forget, if you have a question that you’d like me to answer, it’s really easy to get yours on the show. Just head over to pediacast.org, click on the Contact link and ask away. I do read each and every one of those that come through, and we’ll try to get your question answered on the show.

All right, let’s take a quick break and I will be back to wrap things up, right after this.

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0:49:27

Dr. Mike Patrick: We are back. I just want to thank each and every one of you for taking time out of your day to make PediaCast a part of it. I really do appreciate your support. This does wrap up our time together. PediaCast is a production of Nationwide Children’s Hospital in Columbus, Ohio.

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0:50:09

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Until next time, this is Dr. Mike, saying stay safe, stay healthy and stay involved with your kids. So long, everybody.

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0:51:09

Announcer 2: This program is a production of Nationwide Children’s. Thanks for listening. We’ll see you next time on PediaCast.